Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $23.44 / $371.54	Facility	26	$15.85	$23.44	$371.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $61.66 / $309.03 / $645.65	Facility	TC	$61.66	$309.03	$645.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $63.10 / $245.47	Professional		$19.05	$63.10	$245.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $23.99 / $91.20	Professional	26	$10.23	$23.99	$91.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $138.04 / $316.23	Professional	50	$39.81	$138.04	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $53.70 / $199.53	Professional	TC	$28.84	$53.70	$199.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $69.18 / $223.87	Professional		$41.69	$69.18	$223.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $16.60 / $56.23	Professional	26	$10.72	$16.60	$56.23
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $61.66 / $104.71 / $331.13	Professional	50	$61.66	$104.71	$331.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $52.48 / $162.18	Professional	TC	$30.20	$52.48	$162.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $43.65 / $60.26	Professional		$14.13	$43.65	$60.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $33.88 / $53.70	Facility	26	$28.84	$33.88	$53.70
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $117.49 / $186.21	Facility	TC	$100.00	$117.49	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $100.00 / $190.55	Professional		$42.66	$100.00	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $23.44 / $45.71	Professional	26	$11.75	$23.44	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $77.62 / $147.91	Professional	TC	$30.90	$77.62	$147.91
DeanCare Facility/Professional Facility Modifier TC Low / Median / High Price $223.87 / $269.15 / $354.81	Facility	TC	$223.87	$269.15	$354.81
DeanCare Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $102.33 / $141.25	Professional		$87.10	$102.33	$141.25
DeanCare Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $24.55 / $33.88	Professional	26	$20.42	$24.55	$33.88
DeanCare Facility/Professional Professional Modifier 50 Low / Median / High Price $131.83 / $154.88 / $213.80	Professional	50	$131.83	$154.88	$213.80
DeanCare Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $79.43 / $109.65	Professional	TC	$67.61	$79.43	$109.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $251.19	Facility	26	$100.00	$100.00	$251.19
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $269.15 / $478.63 / $691.83	Facility	TC	$269.15	$478.63	$691.83
Medica Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $104.71 / $302.00	Professional		$43.65	$104.71	$302.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $35.48 / $102.33	Professional	26	$12.30	$35.48	$102.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $60.26 / $229.09	Professional	TC	$30.90	$60.26	$229.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Quartz Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $125.89 / $169.82	Professional		$64.57	$125.89	$169.82
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $229.09 / $229.09	Facility	TC	$100.00	$229.09	$229.09
Quartz Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $213.80 / $295.12	Professional		$46.77	$213.80	$295.12
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $56.23 / $87.10	Professional	26	$13.49	$56.23	$87.10
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $158.49 / $229.09	Professional	TC	$34.67	$158.49	$229.09
Security Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $208.93 / $295.12	Professional		$85.11	$208.93	$295.12
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.20 / $51.29	Professional	26	$24.55	$30.20	$51.29
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $60.26 / $158.49	Professional	TC	$54.95	$60.26	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $61.66 / $144.54	Professional		$40.74	$61.66	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.98 / $38.90	Professional	26	$11.22	$16.98	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $44.67 / $107.15	Professional	TC	$30.90	$44.67	$107.15